Details

Autor(en) / Beteiligte

• Tamai, Kazuya
• Itoi, Eiji
• Takagishi, Kenji

Titel

Proximal Humeral Fractures: Classification and Treatment

Ist Teil von

• Advances in Shoulder Surgery, 2016, p.237-251

Ort / Verlag

Japan: Springer Japan

Erscheinungsjahr

2016

Link zum Volltext

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• Proximal humeral fractures account for 4–5 % of all fractures, with the higher incidence in women. The AO/ASIF system and the Neer’s four-segment classification are used to record the fracture anatomy. The Neer’s classification is more appropriate to provide an anatomic basis for guiding treatment regimens. Generally, conservative treatments can achieve satisfactory healing in minimally displaced and most two-part surgical neck fractures. Surgery is indicated if surgical neck displacement exceeds 20 mm. Intramedullary nails and locking plates are most commonly used. The surgeon should pay attention to the possible varus deformity at the surgical neck. Greater tuberosity fractures are surgically treated if the displacement exceeds 5 mm. A tension band wiring is recommended in elderly patients. Three-part fractures are treated with osteosynthesis employing pins and wires, intramedullary nails, or locking plates. However, hardware complications are not uncommon in patients older than 60 years. In four-part valgus impacted fractures, it is important to elevate the head fragment superiorly for reduction rather than to pull the greater tuberosity inferiorly. For four-part fractures, hemiarthroplasty is the primary treatment of choice, but postoperative functional recovery is unsatisfactory. Although reverse shoulder arthroplasty looks promising, its use should be reserved for elderly patients.